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Benign occipital epilepsy mimicking a catastrophic intracranial event
1Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tiqva. enahum@netvision.net.il
Insights
Benign occipital epilepsy in children can mimic serious neurological events. Early EEG diagnosis is crucial to avoid unnecessary, aggressive treatments and ensure prompt recovery.
Area of Science:
- Pediatric Neurology
- Epileptology
- Emergency Medicine
Background:
- Benign occipital epilepsy is a rare condition.
- Its presentation can be mistaken for severe intracranial pathology.
Observation:
- Three children presented with symptoms mimicking catastrophic intracranial events.
- Symptoms included loss of consciousness, apnea, hemiclonus, and hypertonicity.
- Initial workup involved intubation, brain scans, and lumbar punctures.
Findings:
- Two patients showed classic occipital epilepsy patterns on EEG.
- One patient had bilateral occipital slow waves.
- All patients recovered fully within 24 hours without neurological deficits.
Implications:
- Early electroencephalography (EEG) in pediatric intensive care units is vital.
- EEG can prevent misdiagnosis and unnecessary aggressive treatments.
- Prompt diagnosis facilitates appropriate management and recovery for benign occipital epilepsy.
Objective:
To describe the rare, dramatic, presentation of benign occipital epilepsy.
Methods:
We describe three children who presented to the pediatric emergency department from 1992 to 1996 with a clinical picture of catastrophic intracranial event.
Results:
The main signs and symptoms were loss of consciousness in all patients, apnea in two, hemiclonus in two, general hypertonicity in two, eye deviation in two, fixed dilated pupils in one, and decorticate rigidity in two. All underwent emergency intubation, brain scan, and lumbar puncture, and all were treated with antibiotics, in addition to antiviral drugs in two. Two patients were also treated for suspected increased intracranial pressure. Two patients recovered within a few hours and one within 24 hours of admission without any residual neurologic deficit. Electroencephalograms, done within 48 hours after the event, revealed the classic pattern of occipital epilepsy in two patients and bilateral occipital slow wave in one. A 3- to 5-year clinical and electroencephalographic follow-up supported the diagnosis.
Conclusion:
Benign occipital epilepsy in children can mimic a catastrophic intracranial event. Electroencephalography, performed early in the Pediatric Intensive Care Unit, may avoid or shorten unnecessary and aggressive treatments such as hyperventilation, diuretic agents, and prolonged antiviral therapy.